Dietary quality has a vital role in the prevention of chronic disease. In 2005, the US Department of Agriculture released a new food guide, MyPyramid, because the previous pyramid was in substantial discordance with current scientific evidence. The US Department of Agriculture pyramids are the most visible source of US nutrition policy and dietary guidance and it is, therefore, imperative they provide scientifically derived recommendations for a healthy diet. Unfortunately, MyPyramid strays from much of the evidence generated through years of research and, in our opinion, fails to provide the public with clear information about healthy food choices. In this Review, we discuss the policy and process behind the development of MyPyramid, assess the current evidence linking diet to chronic diseases, including cardiovascular disease, cancer and diabetes, and suggest potential alternatives for dietary recommendations.